Clinical outcomes up to 9 years after [18F]flutemetamol amyloid-PET in a symptomatic memory clinic population

被引:0
作者
Collij, Lyduine E. [1 ,2 ,3 ]
Farrar, Gill [4 ]
Zwan, Marissa [5 ,6 ,7 ]
van de Giessen, Elsmarieke [1 ,2 ]
Ossenkoppele, Rik [3 ,5 ,6 ,7 ]
Barkhof, Frederik [1 ,2 ,8 ,9 ]
Rozemuller, Annemieke J. M. [10 ]
Pijnenburg, Yolande A. L. [5 ,6 ,7 ]
van der Flier, Wiesje M. [5 ,6 ,7 ,11 ]
Bouwman, Femke [5 ,6 ,7 ]
机构
[1] Amsterdam UMC Locat VUmc, Dept Radiol & Nucl Med, Amsterdam, Netherlands
[2] Amsterdam Neurosci, Brain Imaging, Amsterdam, Netherlands
[3] Lund Univ, Dept Clin Sci Malmo, Clin Memory Res Unit, Lund, Sweden
[4] GE Healthcare, Amersham, England
[5] Amsterdam UMC Locat VUmc, Alzheimer Ctr, Amsterdam, Netherlands
[6] Amsterdam UMC Locat VUmc, Dept Neurol, Amsterdam, Netherlands
[7] Amsterdam Neurosci, Neurodegenerat, Amsterdam, Netherlands
[8] UCL, Ctr Med Image Comp, London, England
[9] UCL, Queen Sq Inst Neurol, London, England
[10] Amsterdam UMC Locat VUmc, Dept Pathol, Amsterdam, Netherlands
[11] Amsterdam UMC Locat VUmc, Dept Epidemiol & Data Sci, Amsterdam, Netherlands
关键词
F-18]flutemetamol amyloid-PET; Early-onset dementia; Diagnosis; Survival; Neuropathology; PROGRESSIVE SUPRANUCLEAR PALSY; MILD COGNITIVE IMPAIRMENT; ALZHEIMERS-DISEASE; DIAGNOSTIC-CRITERIA; LEWY BODIES; DEMENTIA; SURVIVAL; PATHOLOGY; ASSOCIATION; MANAGEMENT;
D O I
10.1186/s13195-023-01351-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Previous studies demonstrated increases in diagnostic confidence and change in patient management after amyloid-PET. However, studies investigating longitudinal outcomes over an extended period of time are limited. Therefore, we aimed to investigate clinical outcomes up to 9 years after amyloid-PET to support the clinical validity of the imaging technique.Methods: We analyzed longitudinal data from 200 patients (M-age = 61.8, 45.5% female, M-MMSE = 23.3) suspected of early-onset dementia that underwent [F-18]flutemetamol-PET. Baseline amyloid status was determined through visual read (VR). Information on mortality was available with a mean follow-up of 6.7 years (range = 1.1-9.3). In a subset of 108 patients, longitudinal cognitive scores and clinical etiological diagnosis (eDx) at least 1 year after amyloid-PET acquisition were available (M = 3.06 years, range = 1.00-7.02). VR - and VR + patients were compared on mortality rates with Cox Hazard's model, prevalence of stable eDx using chi-square test, and longitudinal cognition with linear mixed models. Neuropathological data was available for 4 patients (mean delay = 3.59 +/- 1.82 years, range = 1.2-6.3).Results: At baseline, 184 (92.0%) patients were considered to have dementia. The majority of VR + patients had a primary etiological diagnosis of AD (122/128, 95.3%), while the VR - group consisted mostly of non-AD etiologies, most commonly frontotemporal lobar degeneration (30/72, 40.2%). Overall mortality rate was 48.5% and did not differ between VR - and VR + patients. eDx at follow-up was consistent with baseline diagnosis for 92/108 (85.2%) patients, with most changes observed in VR - cases (VR - = 14/35, 40% vs VR + = 2/73, 2.7%, chi(2) = 26.03, p < 0.001), who at no time received an AD diagnosis. VR + patients declined faster than VR - patients based on MMSE (beta = - 1.17, p = 0.004), episodic memory (beta = - 0.78, p = 0.003), fluency (beta = - 1.44, p < 0.001), and attention scores (beta = 16.76, p = 0.03). Amyloid-PET assessment was in line with post-mortem confirmation in all cases; two cases were VR + and showed widespread AD pathology, while the other two cases were VR - and showed limited amyloid pathology.Conclusion: In a symptomatic population, we observed that amyloid-status did not impact mortality rates, but is predictive of cognitive functioning over time across several domains. Also, we show particular validity for a negative amyloid-PET assessment, as these patients did not receive an AD diagnosis at follow-up.
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页数:10
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